Guidelines 1 COVID retningslinje (2024 version 29)
Ændringer siden version 28: Moderat risikogruppe udgår. Gravide udgår som risikogruppe. Skærpelse af kriterier for opstart af Paxlovid (nu kun højrisiko patient med indikation). 2 Antivirale midler til SARS-CoV-2 (2022)
Vurdering af behov for antivirale midler og effekt af SARS-CoV2 infektion i de risikogrupper, som ifølge gældende retningslinjer skal tilbydes behandling med lægemidlet. Værktøj 1 Aktuelle tal (SSI)
2 Aktuelle tal (ECDC)
3 Aktuelle tal (WHO)
4 Aktuelle tal (Johns Hopkins University)
5 Mortalitetsmonitorering (EuroMOMO)
6 Genomic epidemiology of SARS-CoV-2 (Nextstrain)
7 Liverpool COVID-19 drug interactions
8 Standford Coronavirus antiviral & resistance database
Links 1 SSI's epidemiologiske rapporter med særligt fokus på udvalgte perspektiver af COVID-19 udbruddet
2 Sundhedsstyrelsens side om COVID-19
3 Sundhedsstyrelsens retningslinjer for håndtering af COVID-19
4 Sundhedsstyrelsens COVID-19: Risikovurdering, strategi og tiltag ved epidemi i Danmark
5 Sundhedsstyrelsens vejledning: Personer med øget risiko for alvorligt COVID-19 sygdomsforløb
6 Sundhedsstyrelsens Nationale Kliniske Anbefaling: Brug af lægemidler ved forebyggelse og behandling af COVID-19
7 Dansk Selskab for Infektionsmedicins dokument: Patienter med øget risiko for et alvorligt COVID-19 sygdomsforløb
Nye artikler 1 Convalescent plasma and predictors of mortality among hospitalized COVID-19 patients: a systematic review and meta-analysis
Massimo Franchini, Mario Cruciani, Carlo Mengoli, Arturo Casadevall, Claudia Glingani, Michael J. Joyner, Liise-anne Pirofski, Jonathon W. Senefeld, Shmuel Shoham, David J. Sullivan, Matteo Zani, Daniele Focosi Clinical Microbiology and Infection, 27.07.2024 Tilføjet 27.07.2024 Plasma collected from recovered COVID-19 patients (COVID-19 convalescent plasma, CCP) was the first antibody-based therapy employed to fight the COVID-19 pandemic. While the therapeutic effect of early administration of CCP in COVID-19 outpatients has been recognized, conflicting data exist regarding the efficacy of CCP administration in hospitalized patients. Læs mere Tjek på PubMed2 [World Report] Charges brought in Brazilian COVID-19 malpractice case
Marcia Triunfol Lancet, 26.07.2024 Tilføjet 26.07.2024 Several employees of the Prevent Senior hospital chain have been charged over the care of patients during the COVID-19 pandemic. Marcia Triunfol reports. Læs mere Tjek på PubMed3 Pandemic burden in low-income settings and impact of limited and delayed interventions: a granular modelling analysis of COVID-19 in Kabwe, Zambia
Pablo N Perez-Guzman, Stephen Longa Chanda, Albertus Schaap, Kwame Shanaube, Marc Baguelin, Sarah T Nyangu, Muzala Kapina Kanyanga, Patrick Walker, Helen Ayles, Roma Chilengi, Robert Verity, Katharina Hauck, Edward S Knock, Anne Cori International Journal of Infectious Diseases, 26.07.2024 Tilføjet 26.07.2024 The World Health Organization\'s (WHO) Pandemic and Resilience for Emerging Threats (PRET) initiative calls for the formulation of preparedness plans and priority actions underpinned by learnings from the COVID-19 pandemic [1]. Yet, four years on from the emergence of SARS-CoV-2, the true burden of the pandemic and the impact of constraints to scale-up mitigation strategies in resource-limited settings remain poorly understood. Systematic issues with epidemiological surveillance data have been highlighted as a key challenge to undertake such retrospective assessments robustly [2]. Læs mere Tjek på PubMed4 Assessing factors associated with compliance to preventive measures of COVID-19 in Rwanda: a cross-sectional community survey
Mugeni, R., Ruranga, C., Mutezimana, E., Nishimwe, A., Nzabanita, J., Masabo, E., Akili, V., Twizeyimana, L., Bahati, O., Uwimana, A., Musabanabaganwa, C., Semakula, M., Rukundo, G., Jansen, S., Mukamana, L., Rubagiza, J., Twagirumukiza, M. BMJ Open, 26.07.2024 Tilføjet 26.07.2024 ObjectiveTo assess the level of compliance with COVID-19 preventive measures and compliance-associated factors in the Rwanda community. DesignCross-sectional study. SettingsCountry-wide community survey in Rwanda. Participants4763 participants were randomly sampled following the sampling frame used for the recent Rwanda Demographic Health Survey. Participants were aged between 22 years and 94 years. OutcomesThe participants’ compliance with three preventive measures (wearing a face mask, washing hands and social distancing) was the main outcome. MethodsFrom 14 February 2022 to 27 February 2022, a cross-sectional survey using telephone calls was conducted. Study questionnaires included different questions such as participants’ demographics and compliance with COVID-19 preventives measures. Verbal consent was obtained from each participant. The compliance on three main preventive measures (wearing a mask, washing hands and social distancing) were the main outcomes. Univariate and multivariable logistic regression analyses were performed to evaluate factors associated with compliance (age, gender, level of education, socioeconomic status). ResultsCompliance with the three primary preventive measures (washing hands 98%, wearing a mask 97% and observing social distance 98%) was at a rate of 95%. The respondents’ mean age was 46±11 SD (range 22–98) years. In addition, 69% were female and 86% had attended primary education. Bivariate and regression analyses indicated a significant association among the three primary preventive measures (p Læs mere Tjek på PubMed5 Adolescent girls perceptions of the COVID-19 infodemic in Sierra Leone: a qualitative study in urban, peri-urban and rural Sierra Leone
Yillah, R. M., Wurie, H. R., Reindorf, B., Sawaneh, A., Hodges, M. H., Turay, H. BMJ Open, 26.07.2024 Tilføjet 26.07.2024 ObjectiveThis study aimed to identify the primary sources of COVID-19 health information for adolescent girls in Sierra Leone and evaluate their perceived trustworthiness and influence on their behaviour. DesignUsing a convenience sampling strategy grounded in the social cognitive theory, the study explored adolescents\' navigation and appraisal of health information sources, their understanding of COVID-19, and the impact of societal and observational influences on their health beliefs and actions. Data analysis involved thematic analysis using NVivo V.12 software, focusing on patterns within responses related to observational learning, trusted sources and behavioural outcomes. SettingSierra Leone, July 2020. Participants16 focus group discussions were conducted among 86 adolescents (6–8 per group) aged 15–19 years in Sierra Leone. Outcome measurePrimary sources of COVID-19 information. ResultsAdolescent girls identified a diverse range of health information sources, including schools, social media, health workers and radio, with notable differences in trust and preference based on geographical and social contexts. A noteworthy finding was the significant trust placed in health workers, marking a stark contrast to fear and mistrust during the Ebola emergency only 5 years previously. This renewed trust in health professionals emerged as a critical factor influencing adolescents’ health behaviours and acceptance of COVID-19 preventive measures. ConclusionThis study underscores the complexity of navigating health information among adolescent girls during the COVID-19 pandemic. It highlights the importance of tailored public health messaging that accounts for local cultural contexts, addresses misconceptions and builds on trusted information sources to foster effective health behaviours. Future interventions could prioritise enhancing educational resources, leveraging trusted community figures, and ensuring that health communication is scientifically accurate and culturally sensitive. Læs mere Tjek på PubMed6 Decision-making regarding accessing paediatric unscheduled healthcare during the COVID-19 pandemic: a mixed methods rapid review and thematic synthesis
Dowling-Cullen, C., Sakellariou, D. BMJ Open, 26.07.2024 Tilføjet 26.07.2024 ObjectiveReductions in paediatric unscheduled healthcare utilisation were seen during the COVID-19 pandemic, with concerns around their impact on children’s health. The reasons for these changes are not well described. This review aims to explore the factors reported by parents that influenced their decision-making around accessing paediatric unscheduled healthcare during the COVID-19 pandemic. DesignMixed methods rapid review and thematic synthesis based on the Enhancing Transparency of Reporting the Synthesis of Qualitative research framework. Data sourcesMEDLINE, Embase, Web of Science, PsycEXTRA, PsycINFO, Global Health, Global Index Medicus, Dissertations and Theses Global, Google Scholar and OAISter. Studies published from January 2020 to July 2023 were included. Eligibility criteria for selecting studiesQualitative, quantitative and mixed methods studies that assessed the perspectives of parents on decisions to access or delay or avoid accessing paediatric unscheduled healthcare during the COVID-19 pandemic. Data extraction and synthesisNvivo 14.23.0 was used to code results the of the primary studies and develop themes, following a thematic synthesis approach. ResultsTwelve studies were included, all from high-income settings, mainly in Europe. The studies were conducted across varying times and levels of COVID-19-related restrictions. The principal descriptive themes identified were (i) concerns about COVID-19 infection, (ii) balancing and navigating risks, (iii) perception of healthcare service status and conditions and (iv) perception of information and advice. These were developed into analytic themes to further describe the decision-making process. ConclusionsParents balanced a range of risks, concerns, advice and responsibilities when considering accessing paediatric unscheduled healthcare during the COVID-19 pandemic. External sources of advice and information were important; misconceptions around public health advice may reflect the multitude of information sources and the rapidly changing circumstances of the pandemic. Public health policy and planning should consider parent perspectives when developing measures to ensure equitable access to appropriate paediatric healthcare services. Læs mere Tjek på PubMed7 Randomised, double-blind, placebo-controlled study evaluating the effect of allopurinol on the risk of cardiovascular events in patients with high and very high cardiovascular risk, including the presence of long-COVID-19 syndrome: the ALL-VASCOR study protocol
Lewandowska, K., Lipski, D., Uruski, P., Narkiewicz, K., Januszewicz, A., Wolf, J., Prejbisz, A., Rajzer, M., Wiecek, A., Tykarski, A. BMJ Open, 26.07.2024 Tilføjet 26.07.2024 IntroductionNumerous studies, but not all, have suggested a positive effect of allopurinol on the cardiovascular system. The randomised, double-blind, placebo-controlled study evaluating the effect of allopurinol on the risk of cardiovascular events in patients with high and very high cardiovascular risk, including the presence of long-COVID-19 syndrome (ALL-VASCOR) study aims to evaluate the efficacy of allopurinol therapy for improving cardiovascular outcomes in patients at high and very high cardiovascular risk excluding ischaemic heart disease. This is particularly important due to the high cost of cardiovascular disease treatment and its status as one of the leading causes of mortality. Methods and analysisThe ALL-VASCOR study is a randomised, double-blind, placebo-controlled, multicentre trial that examines the effect of allopurinol therapy (200–500 mg of allopurinol daily) versus an equivalent dose of placebo on the risk of cardiovascular events in 1116 patients aged 40–70 with serum uric acid levels above 5 mg/dL at high and very high risk of cardiovascular disease. The ALL-VASCOR study will also assess the occurrence of long-COVID-19 syndrome. The study will measure primary and secondary as well as additional endpoints and the planned intervention will end on 31 July 2028 unless advised otherwise by the Safe Monitoring Board or other applicable authorities. Participant recruitment is planned to begin in March 2024 in Poland. Ethics and disseminationThe study was ethically approved by the Bioethics Committee of Poznan University of Medical Sciences (No 03/23, 12 January 2023). The results are expected after 2028 and will be disseminated in peer-reviewed journals and at international conferences. Protocol version number01–15 November 2022. Trial registration numberEudraCT: 2022-003573-32, 27 October 2022, ClinicalTrials: NCT05943821, 13 July 2023. Læs mere Tjek på PubMed8 The evaluation of risk factors for prolonged viral shedding during anti-SARS-CoV-2 monoclonal antibodies and long-term administration of antivirals in COVID-19 patients with B-cell lymphoma treated by anti-CD20 antibody
BMC Infectious Diseases, 25.07.2024 Tilføjet 25.07.2024 Abstract Background The global impact of the coronavirus disease 2019 (COVID-19) pandemic has resulted in significant morbidity and mortality. Immunocompromised patients, particularly those treated for B-cell lymphoma, have shown an increased risk of persistent infection with SARS-CoV-2 and severe outcomes and mortality. Multi-mutational SARS-CoV-2 variants can arise during the course of such persistent cases of COVID-19. No optimal, decisive strategy is currently available for patients with persistent infection that allows clinicians to sustain viral clearance, determine optimal timing to stop treatment, and prevent virus reactivation. We introduced a novel treatment combining antivirals, neutralizing antibodies, and genomic analysis with frequent monitoring of spike-specific antibody and viral load for immunocompromised patients with persistent COVID-19 infection. The aim of this retrospective study was to report and evaluate the efficacy of our novel treatment for immunocompromised B-cell lymphoma patients with persistent COVID-19 infection. Methods This retrospective descriptive analysis had no controls. Patients with B-cell lymphoma previously receiving immunotherapy including anti-CD20 antibodies, diagnosed as having COVID-19 infection, and treated in our hospital after January 2022 were included. We selected anti-SARS-CoV-2 monoclonal antibodies according to subvariants. Every 5 days, viral load was tested by RT-PCR, with antivirals continued until viral shedding was confirmed. Primary outcome was virus elimination. Independent predictors of prolonged viral shedding time were determined by multivariate Cox regression. Results Forty-four patients were included in this study. Thirty-five patients received rituximab, 19 obinutuzumab, and 26 bendamustine. Median treatment duration was 10 (IQR, 10–20) days; 22 patients received combination antiviral therapy. COVID-19 was severe in 16 patients, and critical in 2. All patients survived, with viral shedding confirmed at median 28 (IQR, 19–38) days. Bendamustine use or within 1 year of last treatment for B-cell lymphoma, and multiple treatment lines for B-cell lymphoma significantly prolonged time to viral shedding. Conclusions Among 44 consecutive patients treated, anti-SARS-CoV-2 monoclonal antibodies and long-term administration of antiviral drugs, switching, and combination therapy resulted in virus elimination and 100% survival. Bendamustine use, within 1 year of last treatment for B-cell lymphoma, and multiple treatment lines for B-cell lymphoma were the significant independent predictors of prolonged viral shedding time. Læs mere Tjek på PubMed9 Efficacy and safety of oral ivermectin in the treatment of mild to moderate Covid-19 patients: a multi-centre double-blind randomized controlled clinical trial
BMC Infectious Diseases, 25.07.2024 Tilføjet 25.07.2024 Abstract Background Evidence on ivermectin as a treatment for Covid-19 is controversial. A Cochrane review concluded that the efficacy and safety of ivermectin is uncertain (evidence up to April 2022) and WHO recommended its use only in the setting of clinical trials. This study aimed to assess the efficacy and safety of oral ivermectin in hospitalized patients with mild to moderate Covid-19. Trial design and methods A double-blind, randomized placebo-controlled clinical trial was conducted among RT-PCR-confirmed, adults, hospitalised within the first four days of symptoms. Patients received oral ivermectin 24 mg or placebo daily for five days. RT-PCR was repeated on days five and ten. Clinical progression was monitored using the World Health Organization Clinical Progression Scale. Serum ivermectin levels were measured on days three, five, and seven. The primary outcome was the difference in the viral load between day zero and ten in the two groups. Results Out of 1699 patients screened, 249 underwent randomization and 127 received ivermectin, and 122 placebo. D10 median viral load for E gene (IQR) was 2,000 copies/mL (100 − 20,500) with ivermectin (n = 80) and 4,100 copies/mL (1,000–65,600) with placebo (n = 81, p = 0.028), per protocol analysis. The difference in Log viral load between day zero and ten between ivermectin and placebo was 3.72 and 2.97 respectively (p = 0.022). There was no significant difference in the WHO clinical progression scale or the adverse effects. Ivermectin blood levels taken before or with meals were not significantly different. Only 7 and 17 patients achieved blood levels above 160ng/ML and 100ng/ML respectively and they did not achieve a significantly lower viral load. Conclusion Although ivermectin resulted in statistically significant lower viral load in patients with mild to moderate Covid-19, it had no significant effect on clinical symptoms. Trial registration number SLCTR/2021/020, Sri Lanka Clinical Trials Registry. 19/07/2021. Læs mere Tjek på PubMed10 Lessons from the COVID-19 pandemic for ventilation and indoor air quality
Lidia Morawska, Yuguo Li, Tunga Salthammer Science, 25.07.2024 Tilføjet 25.07.2024 11 Validating combination throat-nasal swabs for COVID-19 tests would improve early detection, especially for the most vulnerable
Clinical Infectious Diseases, 25.07.2024 Tilføjet 25.07.2024 12 Déjà Vu All Over Again — Refusing to Learn the Lessons of Covid-19
Michael S. Sinha, Wendy E. Parmet, and Gregg S. GonsalvesFrom the Center for Health Law Studies, St. Louis University School of Law, St. Louis (M.S.S.); the Center for Health Policy and Law, Northeastern University School of Law, Boston (W.E.P.); and the Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT (G.S.G.). New England Journal of Medicine, 25.07.2024 Tilføjet 25.07.2024 13 Development and Validation of a Machine Learning COVID-19 Veteran (COVet) Deterioration Risk Score
Govindan, Sushant; Spicer, Alexandra; Bearce, Matthew; Schaefer, Richard S.; Uhl, Andrea; Alterovitz, Gil; Kim, Michael J.; Carey, Kyle A.; Shah, Nirav S.; Winslow, Christopher; Gilbert, Emily; Stey, Anne; Weiss, Alan M.; Amin, Devendra; Karway, George; Martin, Jennie; Edelson, Dana P.; Churpek, Matthew M. Critical Care Explorations, 25.07.2024 Tilføjet 25.07.2024 BACKGROUND AND OBJECTIVE: To develop the COVid Veteran (COVet) score for clinical deterioration in Veterans hospitalized with COVID-19 and further validate this model in both Veteran and non-Veteran samples. No such score has been derived and validated while incorporating a Veteran sample. DERIVATION COHORT: Adults (age ≥ 18 yr) hospitalized outside the ICU with a diagnosis of COVID-19 for model development to the Veterans Health Administration (VHA) (n = 80 hospitals). VALIDATION COHORT: External validation occurred in a VHA cohort of 34 hospitals, as well as six non-Veteran health systems for further external validation (n = 21 hospitals) between 2020 and 2023. PREDICTION MODEL: eXtreme Gradient Boosting machine learning methods were used, and performance was assessed using the area under the receiver operating characteristic curve and compared with the National Early Warning Score (NEWS). The primary outcome was transfer to the ICU or death within 24 hours of each new variable observation. Model predictor variables included demographics, vital signs, structured flowsheet data, and laboratory values. RESULTS: A total of 96,908 admissions occurred during the study period, of which 59,897 were in the Veteran sample and 37,011 were in the non-Veteran sample. During external validation in the Veteran sample, the model demonstrated excellent discrimination, with an area under the receiver operating characteristic curve of 0.88. This was significantly higher than NEWS (0.79; p < 0.01). In the non-Veteran sample, the model also demonstrated excellent discrimination (0.86 vs. 0.79 for NEWS; p < 0.01). The top three variables of importance were eosinophil percentage, mean oxygen saturation in the prior 24-hour period, and worst mental status in the prior 24-hour period. CONCLUSIONS: We used machine learning methods to develop and validate a highly accurate early warning score in both Veterans and non-Veterans hospitalized with COVID-19. The model could lead to earlier identification and therapy, which may improve outcomes. Læs mere Tjek på PubMed14 COVID-19 Across Pandemic Variant Periods: The Severe Acute Respiratory Infection-Preparedness (SARI-PREP) Study
Mukherjee, Vikramjit; Postelnicu, Radu; Parker, Chelsie; Rivers, Patrick S.; Anesi, George L.; Andrews, Adair; Ables, Erin; Morrell, Eric D.; Brett-Major, David M.; Broadhurst, M. Jana; Cobb, J. Perren; Irwin, Amy; Kratochvil, Christopher J.; Krolikowski, Kelsey; Kumar, Vishakha K.; Landsittel, Douglas P.; Lee, Richard A.; Liebler, Janice M.; Segal, Leopoldo N.; Sevransky, Jonathan E.; Srivastava, Avantika; Uyeki, Timothy M.; Wurfel, Mark M.; Wyles, David; Evans, Laura E.; Lutrick, Karen; Bhatraju, Pavan K.; on behalf of the Severe Acute Respiratory Infection-Preparedness (SARI-PREP) Study Group Critical Care Explorations, 25.07.2024 Tilføjet 25.07.2024 IMPORTANCE: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has evolved through multiple phases in the United States, with significant differences in patient centered outcomes with improvements in hospital strain, medical countermeasures, and overall understanding of the disease. We describe how patient characteristics changed and care progressed over the various pandemic phases; we also emphasize the need for an ongoing clinical network to improve the understanding of known and novel respiratory viral diseases. OBJECTIVES: To describe how patient characteristics and care evolved across the various COVID-19 pandemic periods in those hospitalized with viral severe acute respiratory infection (SARI). DESIGN: Severe Acute Respiratory Infection-Preparedness (SARI-PREP) is a Centers for Disease Control and Prevention Foundation-funded, Society of Critical Care Medicine Discovery-housed, longitudinal multicenter cohort study of viral pneumonia. We defined SARI patients as those hospitalized with laboratory-confirmed respiratory viral infection and an acute syndrome of fever, cough, and radiographic infiltrates or hypoxemia. We collected patient-level data including demographic characteristics, comorbidities, acute physiologic measures, serum and respiratory specimens, therapeutics, and outcomes. Outcomes were described across four pandemic variant periods based on a SARS-CoV-2 sequenced subsample: pre-Delta, Delta, Omicron BA.1, and Omicron post-BA.1. SETTING: Multicenter cohort of adult patients admitted to an acute care ward or ICU from seven hospitals representing diverse geographic regions across the United States. PARTICIPANTS: Patients with SARI caused by infection with respiratory viruses. MAIN OUTCOMES AND RESULTS: Eight hundred seventy-four adult patients with SARI were enrolled at seven study hospitals between March 2020 and April 2023. Most patients (780, 89%) had SARS-CoV-2 infection. Across the COVID-19 cohort, median age was 60 years (interquartile range, 48.0–71.0 yr) and 66% were male. Almost half (430, 49%) of the study population belonged to underserved communities. Most patients (76.5%) were admitted to the ICU, 52.5% received mechanical ventilation, and observed hospital mortality was 25.5%. As the pandemic progressed, we observed decreases in ICU utilization (94% to 58%), hospital length of stay (median, 26.0 to 8.5 d), and hospital mortality (32% to 12%), while the number of comorbid conditions increased. CONCLUSIONS AND RELEVANCE: We describe increasing comorbidities but improved outcomes across pandemic variant periods, in the setting of multiple factors, including evolving care delivery, countermeasures, and viral variants. An understanding of patient-level factors may inform treatment options for subsequent variants and future novel pathogens. Læs mere Tjek på PubMed15 Lung Protective Ventilation Adherence and Outcomes for Patients With COVID-19 Acute Respiratory Distress Syndrome Treated in an Intermediate Care Unit Repurposed to ICU Level of Care
Hochberg, Chad H.; Case, Aaron S.; Psoter, Kevin J.; Brodie, Daniel; Dezube, Rebecca H.; Sahetya, Sarina K.; Outten, Carrie; Street, Lara; Eakin, Michelle N.; Hager, David N. Critical Care Explorations, 25.07.2024 Tilføjet 25.07.2024 OBJECTIVE: During the COVID-19 pandemic, some centers converted intermediate care units (IMCUs) to COVID-19 ICUs (IMCU/ICUs). In this study, we compared adherence to lung protective ventilation (LPV) and outcomes for patients with COVID-19-related acute respiratory distress syndrome (ARDS) treated in an IMCU/ICU versus preexisting medical ICUs (MICUs). DESIGN: Retrospective observational study using electronic medical record data. SETTING: Two academic medical centers from March 2020 to September 2020 (period 1) and October 2020 to May 2021 (period 2), which capture the first two COVID-19 surges in this health system. PATIENTS: Adults with COVID-19 receiving invasive mechanical ventilation who met ARDS oxygenation criteria (Pao2/Fio2 ≤ 300 mm Hg or Spo2/Fio2 ≤ 315). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We defined LPV adherence as the percent of the first 48 hours of mechanical ventilation that met a restrictive definition of LPV of, tidal volume/predicted body weight (Vt/PBW) less than or equal to 6.5 mL/kg and plateau pressure (Pplat) less than or equal to 30 cm H2o. In an expanded definition, we added that if Pplat is greater than 30 cm H2o, Vt/PBW had to be less than 6.0 mL/kg. Using the restricted definition, period 1 adherence was lower among 133 IMCU/ICU versus 199 MICU patients (92% [95% CI, 50–100] vs. 100% [86–100], p = 0.05). Period 2 adherence was similar between groups (100% [75–100] vs. 95% CI [65–100], p = 0.68). A similar pattern was observed using the expanded definition. For the full study period, the adjusted hazard of death at 90 days was lower in IMCU/ICU versus MICU patients (hazard ratio [HR] 0.73 [95% CI, 0.55–0.99]), whereas ventilator liberation by day 28 was similar between groups (adjusted subdistribution HR 1.09 [95% CI, 0.85–1.39]). CONCLUSIONS: In patients with COVID-19 ARDS treated in an IMCU/ICU, LPV adherence was similar to, and observed survival better than those treated in preexisting MICUs. With adequate resources, protocols, and staffing, IMCUs provide an effective source of additional ICU capacity for patients with acute respiratory failure. Læs mere Tjek på PubMed16 Time-Dependent Changes in Pulmonary Turnover of Thrombocytes During Critical COVID-19
Aarskog, Nikolai Ravn; Hallem, Ronja; Godhavn, Jakob Strand; Rostrup, Morten Critical Care Explorations, 25.07.2024 Tilføjet 25.07.2024 OBJECTIVES (BACKGROUND): Under normal conditions, pulmonary megakaryocytes are an important source of circulating thrombocytes, causing thrombocyte counts to be higher in arterial than venous blood. In critical COVID-19, thrombocytes may be removed from the circulation by the lungs because of immunothrombosis, possibly causing venous thrombocyte counts to be higher than arterial thrombocyte counts. In the present study, we investigated time-dependent changes in pulmonary turnover of thrombocytes during critical COVID-19 by measuring arteriovenous thrombocyte differences. We hypothesized that the early stages of the disease would be characterized by a net pulmonary removal of circulating thrombocytes because of immunothrombosis and that later stages would be characterized by a net pulmonary release of thrombocytes as normal pulmonary function is restored. DESIGN: Cohort study with repeated measurements of arterial and central venous thrombocyte counts. SETTING: ICU in a large university hospital. PATIENTS: Thirty-one patients with critical COVID-19 that were admitted to the ICU and received invasive or noninvasive mechanical ventilation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We found a significant positive association between the arteriovenous thrombocyte difference and time since symptom debut. This finding indicates a negative arteriovenous thrombocyte difference and hence pulmonary removal of thrombocytes in the early stages of the disease and a positive arteriovenous thrombocyte difference and hence pulmonary release of thrombocytes in later stages. Most individual arteriovenous thrombocyte differences were smaller than the variance coefficient of the analysis. CONCLUSIONS: The results of this study support our hypothesis that early stages of critical COVID-19 are characterized by pulmonary removal of circulating thrombocytes because of immunothrombosis and that later stages are characterized by the return of normal pulmonary release of thrombocytes. However, in most cases, the arteriovenous thrombocyte difference was too small to say anything about pulmonary thrombocyte removal and release on an individual level. Læs mere Tjek på PubMed17 Correction: Risk factors for critical COVID-19 illness during Delta- and Omicron-predominant period in Korea; using K-COV-N cohort in the National health insurance service
Kyung-Shin Lee, Min Jin Go, Youn Young Choi, Min-Kyung Kim, Jaehyun Seong, Ho Kyung Sung, Jaehyun Jeon, Hee-Chang Jang, Myoung-Hee Kim PLoS One Infectious Diseases, 24.07.2024 Tilføjet 24.07.2024 by Kyung-Shin Lee, Min Jin Go, Youn Young Choi, Min-Kyung Kim, Jaehyun Seong, Ho Kyung Sung, Jaehyun Jeon, Hee-Chang Jang, Myoung-Hee Kim Læs mere Tjek på PubMed18 Correction: Cross-sectional survey evaluating the psychological impact of the COVID-19 vaccination campaign in patients with cancer: The VACCINATE study
Daniela Tregnago, Alice Avancini, Lorenzo Belluomini, Ilaria Trestini, Marco Sposito, Jessica Insolda, Federica Bianchi, Teodoro Sava, Chiara Gaiani, Lidia Del Piccolo, Valentina Guarneri, Giuseppe Verlato, Ahmad Tfaily, Roberta Vesentini, Serena Zuliani, Sara Pilotto, Michele Milella PLoS One Infectious Diseases, 24.07.2024 Tilføjet 24.07.2024 by Daniela Tregnago, Alice Avancini, Lorenzo Belluomini, Ilaria Trestini, Marco Sposito, Jessica Insolda, Federica Bianchi, Teodoro Sava, Chiara Gaiani, Lidia Del Piccolo, Valentina Guarneri, Giuseppe Verlato, Ahmad Tfaily, Roberta Vesentini, Serena Zuliani, Sara Pilotto, Michele Milella Læs mere Tjek på PubMed19 Latinx youth’s and parents’ covid-19 beliefs, vaccine hesitancy and vaccination rates: Longitudinal associations in a community sample
Namoonga M. Mantina, Maiya G. Block Ngaybe, Katharine H. Zeiders, Kayla M. Osman, Ada M. Wilkinson-Lee, Antoinette M. Landor, Lindsay T. Hoyt PLoS One Infectious Diseases, 24.07.2024 Tilføjet 24.07.2024 by Namoonga M. Mantina, Maiya G. Block Ngaybe, Katharine H. Zeiders, Kayla M. Osman, Ada M. Wilkinson-Lee, Antoinette M. Landor, Lindsay T. Hoyt Introduction The Latinx population has the second highest COVID-19 death rate among racial/ethnic groups in the United States and less than half of Latinx youth aged 5–17 years old completed their COVID-19 primary vaccination series as of September 2022. COVID-19 vaccine misinformation detrimentally impacts vaccination rates. In this study, we examined factors that predicted Latinx youth COVID-19 vaccine hesitancy and vaccination status. Methods A community-based sample of 290 Latinx parent and adolescent dyads from a Southwestern metropolitan area of the United States who were recruited to complete an online survey at baseline at T1 (August 2020 –March 2021) and one year later. We tested a longitudinal mediation model in which we examined individual and family factors that would predict youth COVID-19 vaccine hesitancy and vaccination status over time. Results Youth’s pandemic disbelief (i.e., the belief that the COVID-19 pandemic is a conspiracy or not real) predicted greater youth’s COVID-19 vaccine hesitancy, and in turn, a lower likelihood of youth’s COVID-19 vaccination. Youth’s pandemic disbelief also predicted greater parent’s vaccination hesitancy which, in turn, predicted greater youth’s vaccination hesitancy and a lower likelihood of COVID-19 vaccination. Parents’ pandemic disbelief predicted their own COVID-19 hesitancy, but not youth hesitancy. Discussion Our study findings provide initial evidence that general pandemic disbelief was a significant driver of vaccine hesitancy and vaccination among Latinx families. The study contributes to the limited research investigating COVID-19 vaccination in the Latinx community and among Latinx youth, further aiding how COVID-19 vaccine disparities can be mitigated among racial/ethnic populations. Læs mere Tjek på PubMed20 Efficacy and safety of oral ivermectin in the treatment of mild to moderate Covid-19 patients: a multi-centre double-blind randomized controlled clinical trial
BMC Infectious Diseases, 24.07.2024 Tilføjet 24.07.2024 Abstract Background Evidence on ivermectin as a treatment for Covid-19 is controversial. A Cochrane review concluded that the efficacy and safety of ivermectin is uncertain (evidence up to April 2022) and WHO recommended its use only in the setting of clinical trials. This study aimed to assess the efficacy and safety of oral ivermectin in hospitalized patients with mild to moderate Covid-19. Trial design and methods A double-blind, randomized placebo-controlled clinical trial was conducted among RT-PCR-confirmed, adults, hospitalised within the first four days of symptoms. Patients received oral ivermectin 24 mg or placebo daily for five days. RT-PCR was repeated on days five and ten. Clinical progression was monitored using the World Health Organization Clinical Progression Scale. Serum ivermectin levels were measured on days three, five, and seven. The primary outcome was the difference in the viral load between day zero and ten in the two groups. Results Out of 1699 patients screened, 249 underwent randomization and 127 received ivermectin, and 122 placebo. D10 median viral load for E gene (IQR) was 2,000 copies/mL (100 − 20,500) with ivermectin (n = 80) and 4,100 copies/mL (1,000–65,600) with placebo (n = 81, p = 0.028), per protocol analysis. The difference in Log viral load between day zero and ten between ivermectin and placebo was 3.72 and 2.97 respectively (p = 0.022). There was no significant difference in the WHO clinical progression scale or the adverse effects. Ivermectin blood levels taken before or with meals were not significantly different. Only 7 and 17 patients achieved blood levels above 160ng/ML and 100ng/ML respectively and they did not achieve a significantly lower viral load. Conclusion Although ivermectin resulted in statistically significant lower viral load in patients with mild to moderate Covid-19, it had no significant effect on clinical symptoms. Trial registration number SLCTR/2021/020, Sri Lanka Clinical Trials Registry. 19/07/2021. Læs mere Tjek på PubMed |
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